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Microsoft word - mental_health_effectiveness_review_executive_summary.doc

A systematic review of the effectiveness of
interventions to improve the physical health of people
with severe mental health problems
Chiara Samele, Angela Hoadley & Linda Seymour
March 2006
Executive Summary

A literature search was carried out to identify studies which
evaluated the effectiveness of interventions to improve the
physical health of people with severe mental health problems.
Reports based on descriptions of projects or individuals' opinions
were not included. Although there is a growing interest in this field,
however, few rigorous studies have been carried out.
Health checks
A review in 2000 of health assessments in primary care for people
with schizophrenia (Roberts et al 2000) concluded that there was
insufficient evidence to suggest that such assessments were
effective in improving mental or physical health. However, there
have been several evaluations since then of models to improve
physical health.
Nurse advisors
The Well-Being Support Programme funded by Lilly in eight mental
health trusts was aimed at the improvement of physical health in
people with a serious mental health problem. In one project
(Ohlsen et al 2005), a nurse advisor took referrals from a care co-
ordinator, consultant psychiatrists and junior doctors. The
advisor's role was to identify physical health problems, not to treat
them. The evaluation was based on initial and subsequent
assessments. Although not all the details of the evaluation are
included in the paper, more than half of overweight patients who
received the two assessments had lost weight and the percentage
of people on unhealthy diets reduced from 60% to 25%.
Primary care service for psychiatric in-patients
Welthagen et al (2004) evaluated a primary care service for
patients admitted to an acute in-patient unit in West London. The
service consisted of a weekly 3-hour session by a GP for 67
patients on three wards and a limited service for older people.
Demand far exceeded capacity and the service had to be
restricted. A range of physical health problems was diagnosed
and new medication prescribed. One in five patients needed
referral to other specialist services. Almost all patients received
health promotion advice, most commonly on smoking cessation.
Promoting healthy living
Bradshaw et al (2005) carried out a systematic review of health
living interventions in the USA and UK. Promising outcomes were
identified from studies of smoking cessation and weight
management interventions.
The provision over 6 months of free fruit and vegetables for people
with schizophrenia was evaluated by McCreadie et al (2005). At
12 and 18 months, the mean number of portions consumed
gradually declined, reflecting non-sustainability; moreover, there
were no changes from baseline plasma micronutrients or body
mass index.
A systematic review of weight management interventions
(Faulkner et al, 2003) found that behavioural, dietary and exercise
interventions showed only small reductions in weight, but the
authors conclude that these were preferable to drugs in terms of
sustained weight loss over time.
Several studies have reported the effectiveness of smoking
cessation interventions for people with mental health problems.
Although quit rates are often lower than the general population, the
reasons for quitting (such as concerns about health) tend to be
similar. Bupropion and nicotine replacement therapy have shown
modest success, especially when combined with some form of behavioural or group therapy. One of the most important predictors of quitting smoking is readiness to change. Steinberg et al (2004) found that people who received motivational interviewing were more likely to take up smoking cessation counselling. Such interviewing consisted of personal feedback based on their level of nicotine dependence and CO levels compared to non-smokers, the consequences of smoking, money spent, importance of quitting, and confidence in ability to quit. Keywords: Health inequalities; Interventions; Mental health


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